Provider Demographics
NPI:1891009833
Name:LISA A. GARNER, M.D.P.A.
Entity type:Organization
Organization Name:LISA A. GARNER, M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-250-1115
Mailing Address - Street 1:3310 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1531
Mailing Address - Country:US
Mailing Address - Phone:972-271-4141
Mailing Address - Fax:972-278-8691
Practice Address - Street 1:3310 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1531
Practice Address - Country:US
Practice Address - Phone:972-271-4141
Practice Address - Fax:972-278-8691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5079207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288128601Medicaid
TXTXB113010OtherPTAN
TX098021105Medicaid
TXTXB113010OtherPTAN
TX288128601Medicaid